Provider Demographics
NPI:1871944298
Name:ACUPRESSURE MLD MASSAGE LLC
Entity type:Organization
Organization Name:ACUPRESSURE MLD MASSAGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANSELMO
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:727-597-8479
Mailing Address - Street 1:12502 GLENDALE CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-2741
Mailing Address - Country:US
Mailing Address - Phone:727-597-8479
Mailing Address - Fax:727-597-8434
Practice Address - Street 1:11721 US HIGHWAY 19
Practice Address - Street 2:#53
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1433
Practice Address - Country:US
Practice Address - Phone:727-597-8479
Practice Address - Fax:727-597-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA69614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty